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Lac/Usc Vip Clinic

Organization Active NPI Family Nurse Practitioner · Los Angeles, CA

NPI 1134445257 · NPPES record last updated Apr 14, 2010

Key facts

NPI
1134445257
Entity type
Organization (NPI type 2)
Primary specialty
Family Nurse Practitioner 363LF0000X
License
18548 (CA)
Legal business name
LAC/USC VIP CLINIC
Practice address
2010 Zonal Ave.
Opd 3P61
Los Angeles, CA 90033
Phone
(323) 226-3961
Fax
(323) 226-2573
NPI assigned
Apr 14, 2010
Organization subpart
No

Authorized official

Name
Ms. Jennifer Perez, M.P.A.
Title
Program Manager
Phone
(323) 226-5217

Corporate family (same tax ID) 24

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

National Provider Directory

Tax ID family
Usc Caruso Department Otolaryngology-Head and Neck Surgery (612 organizations share this tax ID)

Locations

2010 Zonal Ave
#3P61
Los Angeles, CA 90033
Phone (323) 226-3961

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner
Group: 193400000X SINGLE SPECIALTY GROUP		 363LF0000X 18548 CA Yes

Addresses

Primary practice location

2010 Zonal Ave.
Opd 3P61
Los Angeles, CA 90033

Mailing address

2010 Zonal Ave.
Opd 3P61
Los Angeles, CA 90033
Phone (323) 226-3961

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Apr 14, 2010.

{
    "created_epoch": "1271203200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1271203200000",
    "number": "1134445257",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2010 ZONAL AVE.",
            "address_2": "OPD 3P61",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "90033",
            "telephone_number": "323-226-3961",
            "fax_number": "323-226-2573"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2010 ZONAL AVE.",
            "address_2": "OPD 3P61",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "90033",
            "telephone_number": "323-226-3961",
            "fax_number": "323-226-2573"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAC/USC VIP CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-04-14",
        "last_updated": "2010-04-14",
        "status": "A",
        "authorized_official_last_name": "PEREZ",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_title_or_position": "PROGRAM MANAGER",
        "authorized_official_telephone_number": "323-226-5217",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "M.P.A."
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": "CA",
            "license": "18548",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Los Angeles, CA

All providers in Los Angeles, CA · Family Nurse Practitioner in California

Sources for this page

Verify at the official NPI Registry.